Ch 40: Fluid and electrolytes Flashcards by Alyssa Quintela

fluid and electrolytes are involved in almost every what

What is the # 1 indicator of fluid retention

Fluid and electrolytes involved in almost every cellular reaction and function

1 indicator of fluid attention = weight

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What is the most important nutrient in the body

What are the primary functions of water

transport (5)
facilitate what
act as a what for who
what is maintained
body processes (2)

Water = most important nutrient in body

Transport nutrients and waste ,hormones, enzymes, blood

Facilitate cellular metabolism and proper chemical functioning

Act a solvent for (non)electrolytes

Maintain body temperature

Digestion and elimination

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Give the body fluid compartments (ICF/ECF)

-give exact locations for ECF

ICF(in cells): 70% (2/3) 40%

ECF (outside cell): 30% (1/3) 20%

intravascular (plasma) 5%
interstitial (tissue and lymph) 10-15%

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Variations in fluid Content

healthy person water distribution

What factors determine water distribution (three)

How does fluid Content vary in an infant
-what are they more prone to

What do women and obese people have less of and why
-what is lean tissue rich in

Healthy person: 50 to 60% total body weight = water

Factors that determine water distribution:

persons age
body fat
sex

infants have more body fluid and ECF v adult
-infants more prone to fluid volume deficit

Women and those obese have less body water/more body fat
-lean tissue (muscle) is rich in water

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What is fluid intake primarily regulated by where is it located
-what is it stimulated by

Define dehydration

Define hypovolemia

What is the desirable amount of water / day
what is average amount of water per day

Fluid intake regulated by thirst mechanism
located in the hypothalamus
stimulated by dehydration

Dehydration: lost/deprivation of water in body

Hypovolemia: loss of water + loss of electrolytes

Desirable: 1500 to 3500 mL/day
average 2600 mL/ day

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What is the average fluid output per day

What do you want between your I&O’s and what comes about if there’s a deviation

Through losses: give your insensible end sensible losses

average fluid output: 2500 to 2900 mL per day

I&Os should be balanced if there’s a deviation there’s a concern about imbalance

Insensible losses: non-measurable through skin and respiration

Sensible losses: miserable: pee, poop, exudate

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What are the different sources of water comes from

Water sources:

liquid
- greatest provider
Food
- Second largest
Metabolism byproducts

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Define Electrolytes
Define ions
name for positive and negative ions

Give the ECF ions
give the ICF ions

What does mill equivalents describe

Electrolytes: substance that can break into particles called ions

Ions: Atom or molecule caring electrical charge
(+) cation
(-): anion

What ions are mostly found ECF
-Na, Cl, Ca, bicarb

what ions are mostly found ICF
- K, phosphorus, Mg

mEq describes chemical activity “ Chemical combining power”

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What are fluid and electrolyte balance is maintained by

What is the shifting(aka what) regulated by (4)

Define solvents
Define solutes

what is almost every organ and system in the body help to

Fluid and electrolyte balance are maintained by shifting fluids and solutes between ECF and ICF

Shifting (transport) regulated by:

osmosis
diffusion
active transport
capillary filtration

Solvents: fluid that holds substance (H2O)

Salute: substance dissolved in water
((Non) electrolytes)

Almost every organ and system in the body helps maintain fluid homeostasis

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What characters about cell membranes allow solutes to pass through the cell

What is the heaviest relied route for transport

What is the process of osmosis
-Ultimate goal?

Define osmolarity

So membranes are semi permeable that allow solutes to pass through cell membrane

Osmosis is the heaviest relied on route for transport

Osmosis: movement of water from an area of less solutes to more solutes
•EQUILIBRIUM

Osmolarity: concentration

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For modes transportation of fluid

define osmosis

define diffusion

define active transport
-against what

define capillary filtration
-what does it need

Osmosis:
-moving a water from area of ⬇️ solutes to ⬆️ solutes
•EQUILIBRIUM

Diffusion:

freely movement of solutes through a solvent
⬆️ to ⬇️ conc until equilibrium

Active transport: NEEDS ENERGY!!!🔋
-movement from ⬇️ solute concentration to ⬆️ solute concentration v concentration gradient

Capillary filtration: fluid through permeable membrane from higher to lower pressure
•NEEDS
-colloid osmotic pressure: pushing force
-hydrostatic static pressure: pulling force

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Isotonic solution
-what does it have the same concentration of
•give the numerical number

-give Fluid examples

hypertonic solution

what is the concentration
give Fluid examples

Hypotonic solution

what is a concentration
give fluid examples

Isotonic solution = concentration of plasma
• 275 to 295 mmol per deciliter
-D5W
-NS
-LR

hypertonic (shrink) solution: greater concentration V plasma

3% NaCl
D5NS
TPN

Hypotonic (swell) solution: less concentration V plasma
-0. 33% NS
-0.45% NS

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Give your normal values

Na
K
Ca
Mg
 phosphorus 
Cl

Na : 135 to 145 mEq/ L
K   : 3.5 to 5 mEq/L
Ca : 8 to 10 mg/dL
Mg:  1.3 to 2.3 mEq / L
Cl: 97 to 107 mEq per liter

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Sodium

Normal levels

Causes of hypo/hyper natremia

Greatest manifestations hypo/hyper Natremia

Treatments for hypo/hyper natremia

Sodium: Na

Normal: 135 to 145 mEq/L

 Hypo natremia:
• causes
    -diuretics( sodium loss or water gain)
• manifestations: 
   -confusion 
   -cerebral edema 
    -seizures
•Treatment:
   -hypertonic oral and IV solutions
   -Salt

Hypernatremia:
•causes
   -fluid deprivation
• manifestations
   -thirst
   -decrease LOC/disoriented
   -SZ
• treatment:
-water intake 
-low sodium 
-diuretics

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Potassium

Normal levels

Causes of hypo/hyper Kalemia

Greatest manifestations hypo/hyper Kalemia

Treatments for hypo/hyper Kalemia

Potassium: K

Normal: 3.5 to 5mEq/L

Hypokalemia
•Causes
-vomiting
-gastric suctioning
•Manifestations
! Cardiac dysrhythmias! 
-*Muscle weakness
-*leg cramps
•Treatment
-Foods high in potassium
-slow IV push

Hyper kalemia
•causes
-Renal failure
•Manifestations
! Cardiac dysrhythmias!
-Muscle weakness/nausea
•Treatment
-Loop diuretics
-Sodium polystyrene sulfate

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Calcium

Normal levels

Causes of hypo/hyper Calcemia

Greatest manifestations hypo/hyper calcemia

Treatments for hypo/hyper calcemia

Calcium: Ca

8 to 10 mg/dL

Hypocalcemia
•Causes
-Inadequate intake
•Manifestations
-Numbness tingling 
-cramps
•Treatment
-Calcium Food/IV 
-Vitamin D supplements

Hypercalcemia:
•Causes
-Hyper parathyroidism
•Manifestations
-lethargy/confusion
-Increased risk for kidney stones
-n/v
•Treatment
-Calcium restriction
-Increase fluids

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Magnesium

Normal levels

Causes of hypo/hyper Magnesemia

Greatest manifestations hypo/hyper Magnesemia

Treatments for hypo/hyper Magnesemia

Magnesium: MG

1.3 to 2.3 mEq per liter

Hypomagnesemia
•Causes
-NG section 
-alcohol
•Manifestations
-Muscle weakness
-HYPERactive DTR
•Treatment
-Foods high in magnesium/IV

Hyper Magnesemia 
•Causes:
-Renal failure
•Manifestations
-Lethargy
-LOSS OF DTR
•Treatment
-Loop diuretics

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If calcium increases what has an inverse relationship

If potassium decreases what else decreases

If calcium ⬆️ phosphorous will ⬇️ and vice versa

If potassium ⬇️ chloride ⬇️

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Why must your body maintain the acid base balance (3)

What are a few things that can alter the acid balance

what does acid contain that can be shared or released

What can bases do what is an example of a base

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Your body must maintain the acid base balance to sustain

health
homeostasis
life

Conditions like infection and trauma can alter acid base balance

Acid contains hydrogen + they can be liberated or released

Alkali (base) A substance that can accept or trap H+ such as bicarb ions

What is a buffer (what does it prevent)
-how does it prevent it

What are buffer systems that help with the acid-base imbalance

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Buffer:

substance that prevents body fluids from becoming overly acidic or alkaline
combines with excess acid/base to prevent major pH changes

Buffer system:
* carbonic acid sodium bicarbonate
- phosphate 
-protein
• respiratory/renal mechanism

When do acid-base imbalances occur

Metabolic imbalances

-occur as a result of what (disturbance in what level)

How do the lungs and kidneys compensate

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Acid-base imbalances occur when carbonic acid or bicarb levels become disproportionate

Metabolic imbalance is occur from a disturbance in the bicarb level in the ECF

Lungs and kidneys compensate by excreting or retaining CO2 (Lungs) or bicarb and hydrogen ions (Kidneys)

Metabolic acidosis

What causes metabolic acidosis

How does a body respond

What causes metabolic acidosis

How does a body respond

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Metabolic acidosis

By
-excessive loss of bicarb⬇️ or +in H+

Bodies response
- lungs excrete CO2 by TACHYPNEA

Metabolic alkalosis

By:
-excessive acid loss

body‘s response
-body retains CO2 with BRAYDYPNEA
• slow and shallow may have periods of apnea

Why do respiratory in balances occur and what does it alter

How does a body compensate for respiratory disturbances

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Respiratory in balances as a result of respiratory disturbances

Respiratory imbalances altar CO2 and carbonic acid in the ECF

Body compensates for respiratory disturbances by

lung retaining or eliminating CO2
can you try to restore balance with formation or excretion of bicarb

What is respiratory acidosis caused by

What is a body‘s response to respiratory acidosis

What is respiratory alkalosis caused by

What is the body‘s response to respiratory alkalosis

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Respiratory acidosis

Too much CO2 equals a long compensates (increased respiratory rate)

Not enough = body retains CO2

Respiratory alkalosis
Caused by:
-hyperventilation not enough CO2

Body response

Bradypnea
slower shallow breaths

describe what is lost in fluid volume deficit What are components of fluid volume deficit Who is of highest risk for hypovolemia and dehydration What is third space fluid shift and where does it go -What is present

Influe volume deficit there’s a loss of water and solutes in the same proportion Components of fluid volume deficit: (2) - hypovolemia - dehydration Highest risk for hypovolemia/dehydration - children - elder - sickly Third spacing fluid shift a.k.a. intracellular dehydration - shift of fluids into the transcellular (interstitial compartment) - with third spacing Edema is present with dehydration

What happens during fluid volume excess What are the two components of fluid volume excess What will accumulate in the interstitial space

during full volume excess there’s a retention of both sodium and water in the extracellular fluid Two components of the volume excess: - Hypervolemia (intravascular accumulation) - Overhydration Edema accumulates in the fluids of the interstitial space

What are components of the nursing history and physical assessment

Assess the skin makes membranes, vital signs, neurological assessment Assess for symptoms such as: - excessive thirst - N/V/D, - drainage - other fluid losses Get fluid intake and output Get daily weight Get your lab studies - CBC, - serum electrolytes, - BUN, - creatinine - urine pH, - specific gravity - ABGs

When do you want to get patients weights What are parameters for getting patients weights How do you know if a patient is retaining water What is the most accurate way to assess fluid retention

Get a patient’s weight in the morning Must be same time, same clothes, same scale A patient is retaining water if they gain 2.2 pounds (1 L) in 1 to 2 days wait is the most accurate way to assess for Florida attention

What questions you wanna ask during the nursing history Illnesses Abnormal fluids Damage ? (3) Therapies that what

Ask the patient if they’ve had questions: -acute/chronic illnesses • DM,CHF,renal failure -abnormal losses of body fluids -Burns -trauma -surgery - therapies that may just wrecked fluid and electrolyte balance • chemo, diuretics, steroids

What are components of the physical assessment you want to do

Assess skin turgor/ tongue turgor Moisture and oral cavity Tearing and salvation Appearance of skin and skin temperature facial appearance edema pulse, respirations,blood pressure

what does a ⬆️ BP indicate what does ⬇️ BP indicate What may kidney function tell you Give the normal for the ABGs

⬆️ BP: Hypervolemia ⬇️BP: hypovolemia Kidney function can tell you the origin of electrolyte imbalances ABG normals: PH: 7.35 to 7.45 CO2: 45 to 35 HCO3: 22 to 26

What are nursing diagnosis is related to imbalances

(Fluid, electrolyte, acid base disturbances as the problem) - Excess/Deficient fluid volume - Risk for deficient fluid volume - Ineffective breathing pattern Fluid and electrolyte disturbances as etiologies: •Ineffective breathing pattern related to compensatory mechanism by lung hypo ventilation or hyperventilation •Impaired oral mucous membrane integrity related to fluid volume deficit ``` •Risk for impaired skin integrity related to deficient flu of volume or excess fluid volume ```

What is the goal for fluid and electrolyte assessments

The goal for fluid and electrolyte assessments is to maintain and restore optimum functioning related to fluid, electrolyte and acid base balance + Alleviate symptoms and side effects of disease or treatment and prevent complications

How do you wanna teach and develop a dietary plan What do you wanna provide the patient

Teach by involving patient and person who prepares the meal on the nutritional plan Provide the patient with a list of written foods to avoid or include in diet

What are nurses responsibility when it comes to IV fluid therapy What do you do to the iv Orders Concerns Understand what

Initiate monitor and discontinue therapy Evaluate a patient orders before administration Notified provider of any concerns related to the order Understand the rationale for using Ivy therapy, types of solution, desire to effect, potential ADR

What are vascular access devices used for Describe peripheral venous catheters - type - duration Describe central venous access device is - types - duration How long are implanted porch used for who are they placed by

``` Vascular access devices available for delivery of solution and medications to vein Peripheral venous catheters -most common to use ! -used short term ``` ``` Central venous access devices -PICC line -Central lines -peripherally inserted central catheter‘s -tunneled central venous catheter‘s -ports (surgical) • used long-term ``` Implanted ports used for very long-term placed by surgeon

Where does a nurse insert peripheral venous access What do you consider when inserting a peripheral venous access (site selection) When do you need to change the IV site

Nurse puts pressure venous access (most common) in the safest most appropriate location for patient Consider for site selection: - accessibility of vain - condition of vain - type of fluid to be infused - anticipated duration of infusion Change IV site every 72 hours and get a new catheter

IV therapy complications ``` Infiltration Extravasation Phlebitis Thrombophlebitis Infection Systematic complications -fluid overload, embolus, sepsis ```

Infiltration -leakage of fluid into interstitial space because catheter not in vein Extravasation -leakage to surrounding tissue by vesicant causing necrosis ``` Phlebitis -inflammation of vein (Cord) -typically occurs 48 to 72 hours post IV removal Thrombophlebitis -clot causing inflammation in vein Infection ``` Systematic complications -fluid overload, embolus, sepsis

If Phlebitis ( Cord ) develops what actions do you take as a nurse

If phlebitis occurs - discontinue IV - start new IV - apply cold compress

What is the most common complication for IV therapy when dealing with IV and dressing what must you maintain

Most common IV complication = infection When dealing with IV and dressing = sterile

What must you always ensure before giving a blood product What is required before starting an IV

Ensure typing and cross matching most importantly Rh factor!!! Before starting an IV you MUST have doctors orders

When initiating transfusions - what do you want to get -what do you want to ensure (size) -how should the tubing be -what should be taken before starting the blood transfusion -how many nurses must check the blood -how do you want to start the transfusion (for how long) -how long do you stay with the patient

initiating Transfusions: -get informed consent • witness and put in chart - ensure large vein with a needle at 18 to 20 gauge - tubing should be primed with NS - get baseline before starting blood pressure for comparison - two nurses must check the blood - Start a transfusion slow (for 15 minutes) stay with a patient for 15 minutes

What is the maximum infusion time

Max infusion time: 4 hours and throw the rest away

Reactions When will the most severe blood reactions happen Give signs and symptoms of a blood reaction What do you do if suspected blood reaction

Most of your blood reactions will happen within the first 15 minutes Signs and symptoms of a blood reaction: - itching/hives - fever chills - lower back pain - dyspnea ``` If suspected blood reaction: #1STOP Blood -remove old tubing -put new tubing with NS -check vitals -tell doc ```

When is the only time you can slow blood Give signs and symptoms of fluid overload

You can only slow blood if fluid overload S&s - dyspnea - Dry cough

What can you use to evaluate and Readjust your plan interventions What are ways to evaluate if your pt has improved related to fluid and electrolyte balance

Use nursing care plan to evaluate and readjust your plan and interventions Ways to evaluate if your patient has improved related to fluid and electrolyte balance: -is your patient’s urine output equal to their intake - are there abnormal sources of food loss - Are the signs and symptoms of the initial condition absent or improved - is a patient now able to practice self-care behaviors maintain fluid and electrolyte as well as acid base balance

Describe what is happening during the acid base reaction Metabolic alkalosis metabolic acidosis respiratory alkalosis respiratory acidosis

Metabolic alkalosis ➡️ kidneys keep hydrogen excrete bicarb metabolic acidosis ➡️Kidneys excrete hydrogen keep bicarb respiratory alkalosis ➡️Retain CO2 slow breathing respiratory acidosis➡️ Release CO2 fast breathing

Ch 40: Fluid and electrolytes Flashcards

(47 cards)